1. MANAGING
HEALTHCARE
Case-Study of
Singapore

2. Understanding Goals
Students will be able to understand and
appreciate:
The changes in healthcare policies over the
2)
years
The role and responsibilities of the government
3)
in responding to the changing needs in
healthcare
The effectiveness of the healthcare system in
4)
Singapore

3. Different healthcare challenges
faced globally
Developing countries versus
the Developed Countries
Less resources and more
resources
Better health care and not so
good healthcare
Sweden and Africa.(Two extreme
examples)

4. Managing healthcare : What
challenges do governments face?
Equality to all

Countries must provide
healthcare even if citizens
unable to pay
Healthcare a public good-to be
accessible to all citizens
 Balancing other needs
Limited resources-balance with
other needs of the country.

5. Managing healthcare :
What challenges do
governments face?
Providing Quality Healthcare
People live longer due to improved lifestyle
Expectation of better healthcare services
Success of the govt hinges on healthcare
successes
Increasing expenditure on
healthcare
Better treatment due to latest inventions
More healthcare personnel
More expensive

6. How is healthcare paid
for?
Individuals
Pay the doctor when they visit
Personal insurance-For surgery and more
expensive treatments
Employer
Pay a certain sum
Government taxes - to subsidise expensive
treatments

7. Providing Basic Health Care in the 1960s
Improving Health Care Services in the 1970s
Issues in Health Care Services in the 1980s

8. Challenges faced:
• self-government in 1959
• rapid urbanisation led to pollution
• indiscriminate littering
• improper disposal of rubbish
• health care important for nation building
How were challenges handled?
• government responsibility of providing health
care
• more hospitals and clinics built
• island-wide innoculation programme
• routine check-up at schools
• public education on effects of littering through
campaigns like ‘Keep Singapore Clean’

9. Challenges faced:
• wealthier and better-educated people
• demand for better-quality medical services
• need for specialisation of medical services
How were challenges handled?
• polyclinics introduced
- one-stop health centres with variety of services
- located in town centers
• government services improved
- better facilities provided
- better services provided

10. • 1980s –Rising healthcare costs
• Resources were finite
• National Health Plan introduced in
1983 -Manage the healthcare needs in
the long-term
• SHARED RESPONSIBILITY: Three
major components
5) Individual
2) Government
3) Community

11. Challenges faced:
• could not provide very generous subsidies
• need for Singaporeans to be responsible and not
over-rely on state welfare
How were challenges handled?
• Encourage individuals in maintaining good health
• Encourage individuals in self-reliance through
medical savings plans

12. 1) Encouraging the individual in
Maintaining Good Health
Good health ensures less spending on medical

treatments
Health Promotion Board organises activities to

promote healthy lifestyle through physical
exercises and healthy diets
Schools and workplaces have programmes to

emphasise the need to maintain good health

13. 2) Encouraging self-reliance
Encourage individuals in self-reliance

through medical savings plans
individuals pay part of medical expenses

through personal savings such as Medisave
from one’s CPF account
government keeps basic health care

affordable by subsidies e.g. different
subsidies for different ward classes in
government hospitals

14. Individual Self-Reliance : the CPF
The Central Provident Fund (CPF) is a comprehensive

social security savings plan that has
provided many working Singaporeans with a sense of
security and confidence in their old age.
The overall scope and benefits of the CPF encompass the

following:
Retirement
Healthcare
Home Ownership
Family Protection
Asset Enhancement

15. CPF Contributions
Working Singaporeans and their employers
make monthly contributions to the CPF and
these contributions go into three accounts:
1. Ordinary Account (18-22%) - the
savings can be used to buy a home, pay for
CPF insurance, investment and education.
2. Special Account (5-7%) - for old age,
contingency purposes and investment in
retirement-related financial products.
3. Medisave Account (6-8%) - the savings
can be used for hospitalisation expenses and
approved medical insurance.

17. Medical Care for the Masses
Medisave Scheme Medishield Scheme
- compulsory - voluntary
- retirement plan - medical plan
- 6 – 8% salary - small sum through
Medisave

18. Medisave
• Medisave introduced in 1984
• Medisave Account help to build up savings for one’s healthcare
needs
• Medisave can be used to pay for individuals’ or their
dependant(s)' hospitalisation expenses.
• It can also be used for certain outpatient treatments like
chemotherapy and radiotherapy treatments.
• Principle of Co-sharing by the people and the government
• Shared responsibility means there is no need to raise taxes for
healthcare

19. Is Medisave Enough?
when faced with...catastrophic bills, depending
“ However,
solely on Medisave to meet future hospitalisation needs is
not enough. To ensure that Singaporeans can afford
catastrophic bills, members are strongly encouraged to 'risk-
pool' by taking up MediShield.”
“For Singaporeans who would like to stay in higher class wards
upon hospitalisation, they should purchase private
medical insurance plans to complement
Medisave. This would help finance high hospitalisation bills
and stretch the use of Medisave monies.” - CPF Board

21. MediShield
Medisave savings can be used to pay the

premiums for MediShield or private medical
insurance plans under the Private Medical
Insurance Scheme (PMIS).
These are catastrophic medical insurance

schemes for the individuals and their
dependants. They help to defray the high
medical costs of prolonged or serious illnesses.

22. ElderShield
For older CPF members, there is

ElderShield, an affordable severe disability
insurance scheme that provides insurance
coverage to those who require long-term
care.
All Singaporeans and Permanent Residents

(PRs) who are CPF members are
automatically covered under ElderShield
when they turn 40 years old, unless they
opt out of the scheme.

23. “Looks like
everything’s
been taken
care of!”
What are the
assumptions
made in this
comic cartoon?

24. What happens if…
You are unemployed and has insufficient

CPF savings?
You are an ad-hoc part-time worker with

no stable income and CPF?
How can one rely on himself/herself if this
happens?

25. Role of the government
Keep Healthcare Affordable

Ensuring access to healthcare for ALL

Promote healthy lifestyle

Prevention of chronic and contagious

diseases

26. Keeping healthcare affordable
1) Shared responsibility-Individuals and government
2) Government subsidies-Hospitals, polyclinic and
nursing homes e.g. C Class wards-higher subsidy
3) Medifund-$1.6 billion fund (2008) for needy
patients
4) Restructuring of hospitals – hospitals given the
autonomy to reorganise operations in meeting the
needs of Singaporeans which reduces the amount of
subsidies to hospitals
5) Means-testing- Fair distribution of resources –
Lower income group receive higher subsidies

27. Medifund
Medifund is an endowment fund set up by the

Government to help needy Singaporeans who are
unable to pay for their medical expenses.
Medifund acts as a safety net for those who

cannot afford the subsidised bill charges,
despite Medisave and MediShield coverage.
Set up in April 1993 with an initial capital of S$200

million, the Government will inject capital into the
fund when budget surpluses are available.
The Government utilises the interest income from

the capital sum, which stands at S$1.66 billion (FY
2008), to help needy patients who have exhausted
all other means to pay their medical bills.

28. Medical Care for Senior
Citizens
Challenges faced:
Senior citizens need more health care services than others.
How can they cope amidst increasing health costs?
•Health education-Active healthy lifestyle
•Sensible diet
• Campaigns e.g. National Healthy Lifestyle Campaign-
importance of being healthy
•Regular medical check ups
•Ensure enough savings for medical expenses
•Eldershield

29. Role of the Community
Challenges faced:
How can the community play a role in providing healthcare
services to the people?
•Voluntary welfare organisations and private
organisations-Collaborate with the government
•Run community hospitals, nursing homes through
government grants
• e.g.Ang Mo Kio Community Hospital, Ren Ci Hospital,
NKF etc
•Volunteers can offer their services

30. Indicators of Singapore’s
Healthcare success…
“ The Singapore government spent only 1.3 percent of GDP
on healthcare in 2002, whereas the combined public and
private expenditure on healthcare amounted to a low 4.3
percent of GDP. By contrast, the United States spent 14.6
percent of its GDP on healthcare that year, up from 7
percent in 1970...
Yet, indicators such as infant mortality rates or years of
average healthy life expectancy are slightly more
favorable in Singapore than in the United States...
…international experts rank Singapore's healthcare system
among the most successful in the world in terms of cost-
effectiveness and community health results.” –
Singapore’s Success, Henri Ghesquire.

31. Factors leading to success in
managing Healthcare in
Singapore
3Ms

1) Medisave: Individuals pre-save for medical expenses through
mandatory deductions from their paychecks and employer
contribution
2) MediShield: The government provides optional low-cost
catastrophic health insurance
3) Medifund: a safety net quot;subject to stringent means-testing.quot;
Competition between private and public healthcare

- The private healthcare system competes with the public
healthcare, which helps contain prices in both directions.
- Private medicalinsurance is also available.
- Private healthcare providers are required to publish price lists to
encourage comparison shopping.

32. Heavy subsidies from the government

The government pays for basic healthcare services subject to tight
expenditure control. Bottom line: The government pays 80% of
basic public healthcare services.
Prevention policies

Government plays a big role with contagious disease, and adds some
paternalism on top: Preventing diseases such as HIV/AIDS, malaria,
and tobacco-related illnesses by ensuring good health conditions
takes a high priority.
Active role of voluntary organizations and non-government

organizations in the provision of healthcare services and support

33. IN A NUTSHELL…
The public system guarantees health care to all.

A combination of quot;community support and individual

responsibility.quot;
Individuals and their employers contribute almost two-

thirds of funding, much higher than in other developed
countries.
Health Savings Accounts (Medisave) are mandatory.

Emphasis on general well-being and prevention.

Chronic disease management programs are in place and

follow evidence-based medicine guidelines.

34. Have Singapore’s Healthcare
policies met the needs of the
people?
YES
 Ensures that most Singaporeans are taken care of in the
event of any illness
 Medisave, Medishield etc ensure that monetary concerns are
minimal
 As payment is shared by the individual and government there
is not much wastage
 Lower income groups are heavily subsidized particularly if
they take the C ward
 Healthcare in Singapore is more efficient and of better
quality than most countries
 Life expectancy and infant mortality rates are quite
commendable.

35. Have Singapore’s Healthcare
policies met the needs of the
people?
NO
 Despite the various schemes, people who do not
have enough savings are not able to pay
 Need to depend on community and government
 People who are unable to work may not be able to
pay for their health expenses.
 However these people are very few and there are
adequate safeguards to ensure that every
Singaporean is taken care of.